Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation
Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation
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DOI：
10.1016/j.jacc.2021.09.1370
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发表时间：
2021-12-06
影响因子：
24
通讯作者：
Loewen, Peter
中科院分区：
文献类型：
--
作者：
Salmasi, Shahrzad;De Vera, Mary A.;Loewen, Peter
背景传统的坚持总结措施不捕捉动态性质的adherence. Acceptives这项研究的目的是表征不同的长期口服抗凝剂的坚持轨迹和与之相关的因素在patients with atrial fibrillation.METHODS成年人与事件房颤被确定使用链接人口为基础的行政健康数据在不列颠哥伦比亚省，加拿大（1996-2019）。使用基于组的轨迹建模对患者随时间推移所覆盖天数的90天比例进行建模，以确定不同的5年依从性轨迹。结果研究队列包括19，749例AF患者（平均年龄：70.6 ± 10.6岁），56%为男性，平均CHA（2）DS（2）-VASc卒中风险评分2.8 ± 1.4。基于组的轨迹建模确定了4种不同的口服抗凝剂依从性轨迹：“一致依从性”（n = 14，631，74%的队列）、“快速下降和停药”（n = 2，327，12%）、“快速下降和部分恢复”（n = 1，973，10%）和“stow下降和停药”（n = 819，4%）。很少有患者变量被发现与特定的依从性trajectors.CONCLUSIONS之间存在异质性nonadherent患者的服药率和时间下降。发现临床和人口统计学特征不足以预测患者的依从性轨迹。本研究的见解可用于告知依从性干预措施的设计和时机，可能需要进行定性研究，以更好地了解所确定的轨迹中反映的行为的心理社会学决定因素和原因。(C)2021年由美国心脏病学会基金会。
BACKGROUND Conventional adherence summary measures do not capture the dynamic nature of adherence.OBJECTIVES This study aims to characterize distinct long-term oral anticoagulant adherence trajectories and the factors associated with them in patients with atrial fibrillation.METHODS Adults with incident atrial fibrillation were identified using linked population-based administrative health data in British Columbia, Canada (1996-2019). Group-based trajectory modeling was used to model patients' 90-day proportions of days covered over time to identify distinct 5-year adherence trajectories. Multinomial regression analysis was used to assess the effect of various demographic and clinical factors on exhibiting each adherence trajectory.RESULTS The study cohort included 19,749 patients with AF (mean age: 70.6 +/- 10.6 years), 56% mate, mean CHA(2)DS(2)-VASc stroke risk score 2.8 +/- 1.4. Group-based trajectory modeling identified 4 distinct oral anticoagulants adherence trajectories: "consistent adherence" (n = 14,631, 74% of the cohort), "rapid decline and discontinuation" (n = 2,327, 12%), "rapid decline and partial recovery" (n = 1,973, 10%), and "stow decline and discontinuation" (n = 819, 4%). Very few patient variables were found to be associated with specific adherence trajectories.CONCLUSIONS There is heterogeneity among nonadherent patients in the rate and timing of decline in their medication taking. Clinical and demographic characteristics were found to be inadequate to predict patients' adherence trajectories. Insights from this study could be used to inform the design and timing of adherence interventions, and qualitative studies may be needed to better understand the psychosociat determinants and reasons for the behaviors reflected in the identified trajectories. (C) 2021 by the American College of Cardiology Foundation.